How Not to Die

“How Not To Die”
—By Kevin Drum| Thu May. 2, 2013 11:30 AM PDT
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From Dr. Angelo Volandes, on the way physicians routinely treat patients near the end of life:

Physicians are good people. They want to do the right things. And yet all of us, behind closed doors, in the cafeteria, say, “Do you believe what we did to that patient? Do you believe what we put that patient through?” Every single physician has stories. Not one. Lots of stories.

Volandes is making a series of stark videos that he hopes might change that:

The first film he made featured a patient with advanced dementia. It showed her inability to converse, move about, or feed herself. When Volandes finished the film, he ran a randomized clinical trial with a group of nine other doctors. All of their patients listened to a verbal description of advanced dementia, and some of them also watched the video. All were then asked whether they preferred life-prolonging care (which does everything possible to keep patients alive), limited care (an intermediate option), or comfort care (which aims to maximize comfort and relieve pain).

The results were striking: patients who had seen the video were significantly more likely to choose comfort care than those who hadn’t seen it (86 percent versus 64 percent).

Volandes published that study in 2009, following it a year later with an even more striking trial, this one showing a video to patients dying of cancer. Of those who saw it, more than 90 percent chose comfort care—versus 22 percent of those who received only verbal descriptions. The implications, to Volandes, were clear: “Videos communicate better than just a stand-alone conversation. And when people get good communication and understand what’s involved, many, if not most, tend not to want a lot of the aggressive stuff that they’re getting.”